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HomeMy WebLinkAbout05-24-07 (2) REY .1500 EX + (Nt) -," .._. --'. . COMMONwEAlTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. _1 ~SBURG. PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ... z w c ~ c DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL) Kime, Dale J. DATE OF DEATH (MM-D[)"YEAR) DATE OF BIRTH (MM-D[)"YEAR) OFFICIAL USE ONLY FILE NUMBER 21 06 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 166-12-7966 00842 NUMBER 09/10/2006 11/17/1919 THIS RET\JRH MUST BE FIlED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) I!! ll:1- ld~g ~fiil ~ 1. Original Return 4. Limited Estate 6. Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal Poverty Credit (date of death between -31 o 5. Federal Estate Tax Return Required 1 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) m i IRM NAME (If applicable) ~ ~ Law Offices of Debra K. Wallet ElEPHONE NUMBER 717/737-1300 ~ ~ ::;) ! lII: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent. Mortgage Liabilities. & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 3. Remainder Return (date of death prior to 12-13-82) 24 North 32nd Street Camp Hill, PA 17011 (1) None (2) 1,506.75 (3) None (4) None (5) 131,862.19 (6) 5,197.10 (7) 14,125.71 OFFICIAL U~.9Nl Y C:,":;J c.;,..."? --..l -, r-Tl (-) C'''"",,! ',':J 12, Net Value of Estate (Line 8 minus Line 11) ___.~u -:'''" =< 1',) ~ . J -':~ :'J (8) 152,691.75 (9) (10) 12,337.40 148.42 (11) 12,485.82 140,205.93 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (12) (13) (14) 140,205.93 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Copyright 2000 form software only The Lackner Group, Inc. 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec, 9116(a)(1.2) p. 16. Amount of Line 14 taxable at lineal rate 140,205.93 x .045 (16) g II. 17. Amount of Line 14 taxable at sibling rate x .12 (17) 2 8 ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 6,309.27 6,309.27 Form REV-1500 EX (Rev. 6'()0) 06 Decedent's Complete Address: STREET ADDRESS 375 Claremont Drive CITY Carlisle ISTATE PA I ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 6,309.27 6,000.00 315.46 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 6,315.46 Totallnterest/Penalty (0 + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This Is theOVERPAYMENT. (4) Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE (5) A. Enter the interest on the tax due. (SA) 8. Enter the total of Line 5 + SA. This is theBALANCE DUE (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 6.19 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or Income of the property transferred;............................................................................. ~ I b. retain the right to designate who shall use the property transferred or its income;................................ c. retain a reversionary interest; or............................._........................................................................... d. receive the promise for life of either payments, benefits or care?........................................................... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.. ....... ...... ...... ...... .......... ...... ...... ............... .... ...... ..... ...... ........... ..... ........ ... 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?.............................._............................................................................... ~ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of J)eljury, I declare that I have examined this retum, Including ac:ccmpanying sdledules and statements, and to the best of my knowledge and belief. it Is true. correct and complete. Declaration preparer other than tha personal IaUve Is based on alllnfonnation of which rer has an knowled . SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE Marti . Ki e ADDRESS 2400 Deerview Drive Mechanicsburg, P A 17055 ;2. SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Debra K. Wallet \...D4.fIw, ". ~ ADDRESS DATE 24 North 32nd Street Camp Hill, PA 17011 5'/2' I O~ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate Imposed on the net value of transfers to or for the use of the surviving spouse Is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (Ii)]. The statutedoes not exemDta transfer to a surviving spouse from tax, and the statutory requirements for dlsdosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)). The tax rate Imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted In 72 P.S. ~9116 1.2) [72 P.S. ~9116 (a) (1 )]. The tax rate impoSed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling Is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. . SCHEDULE B STOCKS & BONDS COMMONwEAI.m OF PENNSnVANIA INHERITANCE TAX RETURN RESIDENT DEceDENT ESTATE OF Kim D I J e, ae . I FILE NUMBER 21 - 06 - 00842 All property Jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF NUMBER DEATH I 21 shares of Prudential Financial, Inc. 71.75 1,506.75 TOTAL (Also enter on line 2, Recapitulation) 1,506.75 . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONwEAlTH OF PENNSnVANIA INHERITANCE TAX RETURN RESIDeNT DeceDeNT ESTATE OF Kim e, Dale J. I FILE NUMBER 21 - 06 - 00842 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 12,158.90 PNC Bank Checking Account #5070080985 2 PNC Bank Performance Money Market Account #5004217664 3,397.94 3 Putnam Allstate Annuity #ACI010394A 113,191.72 4 Cumberland County VA Allowance 100.00 5 2006 Federal Income Tax Refund 785.00 6 Country Meadows refund 2,126.63 7 Cash in possession of Decedent 27.00 8 Inexpensive watch, wedding band 75.00 TOTAL (Also enter on Line 5, Recapitulation) 131,862.19 . SCHEDULE F JOINTLY -OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kime, Dale J. I FILE NUMBER 21 - 06 - 00842 If an asset was made Joint within one year of the decedent's date of death, It must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME A Martin G. Kime ADDRESS RELATIONSHIP TO DECEDENT 2400 Deerview Drive Mechanicsburg, P A 17055 Son JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial Institution and bank account number DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT or similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENrSINTEREST estate. I A 08/24/2005 PNC Bank Certificate of Deposit 10,394.19 50% 5,197.10 #31100298437 TOTAL (Also enter on line 6, Recapitulation) 5,197.10 . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kime, Dale J. FILE NUMBER 21 - 06 - 00842 This schedule must be completed and filed If the answer to any of Questions 1 throu, h 4 on page 2 Is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF NUMBER Include the name of the transferee. their relationship to decedent and the date of transfer. VALUE OF ASSEl DECD'S EXCLUSION TAXABLE VALUE Attach a copy of the deed for real estate. INTEREST (IF APPLICABLE) I Putnam Allstate Annuity #AC1008502A 12,647.77 100% 12,647.77 2 PNC Bank IRA #5102-5459-1 1,477.94 100% 1,477.94 TOTAL (Also enter on line 7, Recapitulation) 14,125.71 . COMMClNWEAlTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCIfiXJLE H FlN:RALEXPENSEs& AlM\BTRA11VE COSTS ESTATE OF Kim D I J e, a e . Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: Malpezzi Funeral Home 2 Gratuity to Alter Boys 3 Drycleaning of suit for burial DESCRIPTION B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Martin G. Kime Social Security Number(s) I EIN Number of Personal Representative(s): 167-40-0729 Street Address 2400 Deerview Drive City Mechanicsburg Year(s) Commission paid 2007 2. Attorney's Fees Debra K. Wallet, Esq. State P A Zip 17055 3. Family Exemption: (If decedent's address is not the same as c1aimanfs, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent 4. Probate Fees 5. Accountanfs Fees 6. Tax Retum Preparer's Fees Barbush & Hoffman 7. 1 Other Administrative Costs Photocopies, postage, mileage State Zip TOTAL (Also enter on line 9, Recapitulation) I FILE NUMBER 21 - 06 - 00842 AMOUNT 558.40 60.00 17.00 7,600.00 3,500.00 352.00 200.00 50.00 12,337.40 . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE liABiliTIES, & LIENS CClMMONwEAI. TH OF PENNSYLVANIA INlERlTANCE TAX RETURN RESIDENT oeCEDENT ESTATE OF Kime, Dale J. I FILE NUMBER 21 - 06 - 00842 Include unrelmbursed medical expenses. ITEM NUMBER 1 Caremark (prescriptions) DESCRIPTION AMOUNT 45.00 2 West Shore EMS 3 55.15 MCI (telephone) 48.27 TOTAL (Also enter on Line 10, Recapitulation) 148.42 REV.1513 EX+ (NO) . SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Kim I e, Da e J. I FILE NUMBER 21 - 06 - 00842 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE Oft ... I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) I Martin G. Kime Son 100,000.00 2400 Deerview Drive Mechanicsburg, P A 17055 2 Beth Warner Granddaughter II2 of residuary estate 287 West Pheasant Hill Drive Duncan, SC 29334 3 Greg Cline Grandson II2 of residuary estate 246 Colony Lakes Drive Lexington, SC 29073 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAl OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-15OO COVER SHEE LAST WILL AND TESTAMENT OF DALE J. KIME I, DALE J. KlME, unremarried widower, of Mechanicsburg, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish a~d declare this to be my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. For purposes of clarification and interpretation of my intentions as expressed hereinbelow, I am providing the following information: I have already provided during my lifetime considerable financial assistance and monetary gifts to my daughter, CHRIS CLINE. For purposes of this will and its interpretation, I have put a value on the said assistance and gifts of one hundred thousand ($100,000.00) dollars. It is my general intention herein to see to it that my son, MARTIN G. KlME, receive an equal amount on a net basis if he survives me. For further clarification I herein set forth various accounts which I, as of this date, hold with or through PNC Bank, N.A. and/or its investment affiliates: A. Putnam Allstate Variable Annuity #PA00083439 having an approximate value of one hundred fifteen thousand ($115,000.00) dollars. This is currently made payable to my estate in order to provide my estate with, among other things, greater financial capital and liquidity. B. PNC Bank personal checking account having an approximate value of fifteen thousand ($15,000.00) dollars. C. PNC Bank money market account having an approximate value of three thousand ($3,000.00) dollars. Under current arrangements, items A., B., and C. will become part of my probate estate and become part of the residue of my estate and will be subject to division and distribution under the - - In the event my said son has failed to survive me, then his inheritances under this will shall lapse and shall be considered part of the residue of my estate. The residue shall then be divided equally between my two (2) aforesaid grandchildren, /liil:. ~. 6. I nominate, constitute and appointment my son, MARTIN G. KIME, to be the Executor of this, my Last Will and Testament. In the event that my son, MARTIN G. KIME, is unable to unwilling to act as Executor, than I appoint my granddaughter's husband THOMAS WARNER, currently of 287 Pheasant Hill Drive, Duncan, South Carolina 29337, to be the Executor of this, my Last Will and Testament. I further direct that they shall not be required to file fond or other security in the Office of the Register of Wills for the purpose of administering my estate. I make it known hereby to my Executor that I have established an educational trust fund through PNC Bank which is currently set up to be distributed other than through this will. In the event any death taxes are due thereon, I direct my Executor to pay the same from the residue of my estate provided my estate is sufficiently large to support the payment of the same. Such payment from the residue to be made regardless of any effect it may have upon the ultimate value of the priority gift assigned to my son hereinabove. . 1N;)l-TNESS WHEREOF, I have hereunto set my hand and seal this ~ ' A.D. 2005. / lit. day of ~~~ ~~ D J. .-/ Signed, sealed, published and declared by the above-named DALE J. KIME, as and for his Last Will land Testament, in the presence of us, who at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. ~~~ "-~._-'''..'''''"''''''~~0Ri ~ REV-485 EX (05-04) .taid SAFE DEPOSIT ~ BOX INVENTORY PA Department of Revenue Social Security or Death Certificate Number Date of Death 48500041046 C" ~ L .2 7 Decedent's Last Name PLEASE USE ORIGINAL FORM ONLY County Code Year File Number Qct,'L...9,5s~x9 "l'o First'Name~" MI .,0 ;;ATE: ZIP COD5;. I) ();)' S b. NAME: Ie '^"-'L D~ STATE: ZIP CODE: yA J;>osS- STREET ADDRESS: CITY: STATE: ZIP CODE: c. NAME: RELATIONSHIP: STREET ADDRESS: CITY: STATE: ZIP CODE: NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED L) .-RTATE: ZIP CO~ r'l't /70)-J ATE AND TIME OF LAST ENTRY 2. 0 ') /)..', s- "- H BOX IS REQUESTED t.;~~ .DLllAL ~TATE: ZIP CODE: I,/A 17o)~ b. NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: II- l 5!,...,~oV ~ ~ "'- .,cs c.. "'~//~/OJ t ~/ ~/b'-/ If yes, a. Date of will: b. Name and address of personal representative, If named In the will NAME: f1 A YL ~""v C. b '^"L STREET ADDRESS: 2 0 0 i) (/tit. v 'c. "l;' CITY: I1tJrtlt.1 'co STATE: flit- ZIP CODE: )')OJ c. Name and address of attorney, If any NAME: i) \ . ) .t..'D~ STREET ADDRESS: 2 <.j t.J~l)L t- IJ. r- CITY' If ' (AlA(. t,/I! STA/4 ZIP CODE: 1/011 L 48500041046 48500041046 --1 REV-485EX SAFE DEPOSIT BOX INVENTORY INSTRUCTIONS Page of (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, Le., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages. Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 ITEM NO. ITEM DESCRIPTION l t I gltAN- ~ t11'1.tl "- 3> "2 'VI NOTE: Attach additional 81/." x 11" sheet(s) if necessary or use duplicates of this page of form. The Department is authorized by law, 42 U.S.C. ~05 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The Department uses the Social Security number to identify the decedent and personal representatives of the estate. The Commonwealth may also use the information in exchange of tax information agreements with Federal and local taxin authorities. The state law prohibits the Commonwealth's personnel from disclosin confidential tax information except for official purposes.